Port Site Hernias Following Laparoscopic Ventral Hernia Repair
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ORIGINAL SCIENTIFIC REPORT
Port Site Hernias Following Laparoscopic Ventral Hernia Repair Naila H. Dhanani1 • Karla Bernardi1 • Oscar A. Olavarria1 • Deepa Cherla1 • Lillian S. Kao1 Tien C. Ko1 • Mike K. Liang1 • Julie L. Holihan1
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Accepted: 16 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Port site hernias (PSH) are underreported following laparoscopic ventral hernia repair (LVHR). Most occur at the site of laterally placed 10–12-mm ports used to introduce large pieces of mesh. One alternative is to place the large port through the ventral hernia defect; however, there is potential for increased risk of surgical site infection (SSI). This study evaluates the outcomes when introducing mesh through a 10–12-mm port placed through the hernia defect. Methods This was a retrospective case series of patients who underwent LVHR in three prospective trials from 2014–2017 at one institution. All patients had mesh introduced through a 10–12-mm port placed through the ventral hernia defect. The primary outcome was SSI. Secondary outcomes were hernia occurrences including recurrences and PSH. Results A total of 315 eligible patients underwent LVHR with a median (range) follow-up of 21 (11–41) months. Many patients were obese (66.9%), recently quit tobacco use (8.8%), or had diabetes (18.9%). Most patients had an incisional hernia (61.2%), and 19.2% were recurrent. Hernias were on average 4.8 ± 3.8 cm in width. Two patients (0.6%) had an SSI. Fourteen patients had a hernia occurrence—13 (4.4%) had a recurrent hernia, and one patient (0.3%) had a PSH. Conclusion During LVHR, introduction of mesh through a 10–12-mm port placed through the hernia defect is associated with a low risk of SSI and low risk of hernia occurrence. While further studies are needed to confirm these results, mesh can be safely introduced through a port through the defect.
Keywords Laparoscopy Port Hernia
Introduction This abstract was previously presented at the Society of American Gastrointestinal and Endoscopic Surgeons annual meeting April 3–6, 2019 in Baltimore, Maryland. & Naila H. Dhanani [email protected]; [email protected] 1
Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, 5656 Kelley St, Houston, TX 77026, USA
Laparoscopic ventral hernia repair (LVHR) as compared to open ventral hernia repair has been proven to decrease surgical site infection (SSI) with no difference in hernia recurrence [1]. However, in order to introduce large pieces of mesh, a 10–12-mm port is often used, and this site is at risk for port site hernia. Port site hernias are often underdiagnosed and not reported as a ‘‘hernia recurrence.’’
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World J Surg
The exact incidence of port site hernias following LVHR is unclear but ranges from 0 to 40% of all laparoscopic operations [2]. They typically occur at 10–12-mm port sites [2]. Patients are at increased risk for developing hernias due to comorbid conditions (e.g., obesity, smoking) and poor wound healing (e.g., genetics,
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